Review of philos plate fixation in proximal humerus fractures

Abstract

Purpose: To review Philos plate fixation at our institution. Methods: We undertook a retrospective review of Philos plate fixation between January 2005 and November 2010. Preoperatively, fractures were classified according to Neer’s classification. First postoperative and most recent AP radiographs were used to assess inferomedial support (presence or absence of calcar screws), adequacy of reduction by measuring the neck-shaft angle, and loss of reduction by measuring the height between the humeral head and the proximal end of the plate. Complications and further procedures were also evaluated on postoperative radiographs. Results: Follow-up was possible in 67 patients, mean age 88 years (range 23–108 years). Therewere 41 2part fractures, 23 three part fractures and 3 four part fractures. Fifty five patients had calcar screws in situ (18 with 1 calcar screw, 37 with 2 calcar screws). Mean loss of reductionwas 2mm (3mm for no calcar screws, 1mm for1calcar screwand3mmfor2calcar screws). Tenpatientsunderwent further surgery for either screw perforation into the joint or plate failure. Mean neck-shaft angle was 131◦ in patients who did not undergo a further procedure (no calcar screw 129◦, 1 calcar screw 132◦, 2 calcar screws 134◦) compared with 112◦ in patients whounderwent revision (no calcar screw117◦, 1 calcar screw120◦, 2 calcar screws 107◦). Conclusion: Results of failed surgical fixation of proximal humerus fractures canbedevastating. Previous studies using Philos plates suggest good results. The use of calcar screws has been suggested to provide mechanical support in the inferomedial humeral head and prevent loss of reduction. In our case series, restoration of an adequate neck-shaft anglewas themost important determinant in fixation. If this was not achieved, despite adequate inferomedial support, screw perforation or plate failure occurred.